What is the treatment for urinary tract infection (UTI)?

From the Guidelines

To treat a urinary tract infection (UTI), clinicians should use first-line therapy, such as nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), or fosfomycin, dependent on the local antibiogram, for a duration of no longer than seven days 1. When selecting an antibiotic, it is essential to consider the local resistance patterns and the potential for collateral damage. The three first-line agents available in the United States (i.e., nitrofurantoin, TMP-SMX, fosfomycin) are effective in treating UTI and are less likely to produce collateral damage than second-line agents 1. Some key points to consider when treating UTIs include:

• Using antibiotics for as short a duration as reasonable, generally no longer than seven days 1
• Considering the use of culture-directed parenteral antibiotics for patients with UTIs associated with urine cultures resistant to oral antibiotics 1
• Drinking plenty of water to help flush bacteria from the system
• Managing pain and discomfort with over-the-counter pain relievers like ibuprofen or acetaminophen
• Avoiding irritants like caffeine, alcohol, and spicy foods
• Seeking immediate medical attention if symptoms include fever over 101°F, back pain, or vomiting, as these may indicate a kidney infection. It is crucial to complete the entire prescribed course of antibiotics, even if symptoms improve, to ensure the infection is fully cleared 1.

From the FDA Drug Label

Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa Levofloxacin tablets are indicated for the treatment of acute pyelonephritis caused by Escherichia coli, including cases with concurrent bacteremia Levofloxacin tablets are indicated for the treatment of uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus

Levofloxacin (PO) can be used to treat urinary tract infections. The following types of urinary tract infections can be treated with levofloxacin:

• Complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis
• Complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa
• Acute pyelonephritis caused by Escherichia coli
• Uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus 2

From the Research

Treatment Options for Urinary Tract Infections

• The recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females is a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam 3.
• High rates of resistance for trimethoprim-sulfamethoxazole and ciprofloxacin preclude their use as empiric treatment of UTIs in several communities, particularly if patients who were recently exposed to them or in patients who are at risk of infections with extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales 3.
• Second-line options include oral cephalosporins such as cephalexin or cefixime, fluoroquinolones and β-lactams, such as amoxicillin-clavulanate 3.

Resistance Patterns and Prescribing Habits

• The overuse of fluoroquinolones and the underuse of first-line antibiotic agents contribute to guideline discordance in the treatment of uncomplicated urinary tract infections 4.
• Patients aged 18 to 29 years and 30 to 44 years had a statistically significantly higher likelihood of receiving guideline-concordant treatment than patients aged 45 to 75 years 4.
• Obstetricians-gynecologists and urologists had a statistically significantly higher likelihood of concordant treatment than all other specialties combined 4.

Effectiveness of Recommended Antibiotics

• Oral antibiotics with comparatively lower resistance rates were amoxicillin/clavulanate, cefdinir, cefuroxime, and nitrofurantoin 5.
• Oral antibiotics with notably high resistance rates included trimethoprim-sulfamethoxazole (TMP-SMX), tetracycline, ciprofloxacin, levofloxacin, and cephalexin 5.
• Nitrofurantoin was prescribed most frequently for outpatient treatment of UTI/cystitis, while cephalexin was the most commonly prescribed antibiotic for outpatient treatment of pyelonephritis 5.